Legal/Ethical staff issues

Home Health Columnist / Guide · Nov 1, 2006

1. Most hospitals in PA/NJ/DEL have no clothing allowance nor provide uniforms outside OR personnel. Uniform costs are deductible on tax forms.

2. Beverage/food at desk is an infection control and JCAHO violation issue for years. . It's well known that 12 hr nurses are actually Camels in disguise Usually closed lid container (water bottle) is permitted if out of sight. Sorry your break room out of the way...something to consider if/when they do ER redesign.

3. Smoke free/environmentally green facilities is BIG as tobacco settlements anti-smoking push by towns/states for health reasons occurring. Those in my area going smoke free have offered smoking cessation support to both patients and staff.

4. Depends on state law if breaks even covered under state law. Some states have healthcare worker provisions covering "essential" personnel ---ER professional staff would fall under that category. Look at your facilities P+P manual for guidance re break time.

5. Policy re: "leaving the hospital grounds is considered patient abandonment even if on a break or at lunch, and punishable by immediate termination." is standard across many small healthcare facility employers for nursing staff, part of the pitfalls in working such organization as they are mandated by state/federal guidelines to have staffing available for emergencies at all times.

I feel your pain as do many of our bb members. These are all issues often not considered by those considering nursing positions and have a huge impact on job and personal satisfaction.....

morte, LPN, LVN · Nov 1, 2006

union

HuggyPuglet · Nov 1, 2006

I work in a small community hospital, emergency room. The hospital is very involved in this big push for customer service right now. Though many of the changes are patient based and generally well accepted, many of them are very insensitive and border on legal and ethical issues with staff. For instance, many workers have been forced to change uniforms with a week's notice, being measured for and getting one to two uniforms given to them, having to pay exorbitant prices if they want more (obviously having one uniform when you work 6 or 7 days in a row will be an issue). In the beginning of the year, nurses will be required to change to white uniforms, with no clothing allowance or uniforms given (i as well as most nurses spend several hundred dollars a year on the navy uniforms we have worn for years and now will have absolutely no use for). Starting today, we are no longer allowed to have any food or drinks anywhere on the unit, which i totally understand the food, but our break room is very out of the way from the rest of the unit, and anyone working 12 hr shifts in a busy er knows you are lucky if you get 10 mins to eat a lunch let alone get breaks where you can get something to drink. I don't see how i can be made to run like crazy all those hours and not be allowed to have a bottle of water in the nursing station, which is high enough to be totally out of view of any patients. Imagine telling someone in a desk job that they are allowed to drink only on their breaks, that's ludicrous. Also, and yes, i am a smoker, and beginning in jan 1, we are no longer allowed to smoke anywhere on hospital property, including outside, parking lots, etc, there will be no designated smoking area. The kicker is, leaving the hospital grounds is considered patient abandonment even if on a break or at lunch, and punishable by immediate termination. Can a job legally say what i can or can't do on a break?? any input from others going through something similar would be great.

Exhorbitant prices for arbitrary uniform changes?

No food or even drinks in a break room, even away from the nurses station?

And as always, a patient load that precludes the nurse from even getting a full break or lunch, let alone time to get to the bathroom?

And the powers that be wonder why there is a nursing shortage? :angryfire Oh puleeze! I feel your pain....

Regarding smoke breaks, I'm sorry but I can't support you there. We have several smoking nurses on our unit but none of them smoke at the hospital or while on duty. I recently saw a patient with reactive airway disease react very badly to the smoke carried on clothing by a visiting family member. It was frightening for everyone concerned, especially the patient. Rare, yes, but why take the chance? I can't think of one hospital in our area that allows smoking anywhere on the grounds, although most of our extended care facilities seem to allow it. Even visitors to the hospital don't have a place to smoke and they seem to manage for the duration. Can you keep your smoking to lighting up on you way home from work, or on days when you aren't on duty?

But I didn't mean for this to be a rant on smoking anyway. I've never smoked myself, but I have friends and relatives who do and I know just how hard it is for them to kick the habit even when they truly tried and others who simply choose not to try because it is enjoyable to them.

I seriously do feel for your situation and the arbitrariness of the decisions being made. I wish I could offer more ideas but I just don't have them. Perhaps others in this forum might have better ideas.

BSNtobe2009 · Nov 1, 2006

Yup, I think it won't be long before unions will make a major re-appearance in the workforce across all professions.

Remember how unions got started: From Corporate abuse.

As long as companies keep making the workplace more and more unbearable for employees, and keep taking away benefits, and demanding more, and not giving pay raises and having unequal pay scales...they will most definitely come back.

I think a job as physical as nursing and not getting enough water, is unhealthy. (Aren't they supposed to be promoting health for patients AND employees?) I agree that it is an infectious control issue, but the hospital should be working for an alternative if they are going to have people work long hours.

RunnerRN, BSN, RN · Nov 1, 2006

I can (kind of) feel your pain....

My hospital went to white tops/navy bottoms as our uniforms a few years ago. They did, however, give us a clothing allowance that first year. Not quite understanding why they're measuring you for new uniforms though.

On the food/drink issue, you and your coworkers need to make a stink as soon as it goes through. Insist on your breaks, and if a manager says something about it, respond respectfully that since you can no longer even drink water during your shift, you HAVE to take your 30 min lunch break to avoid passing out. Honestly, I would keep a bottle of water in your bag and take a swig from it whenever possible. We go through this every year when JCAHO comes in, but we have an area where we are allowed to put all the beverages that is actually in the dept, not out of the way. Then JCAHO leaves and we're all back to eating lunch at our desks and having our drinks out. (I work in a busy Lvl 1)

With regard to smoking, I am not a smoker, so that doesn't really bother me. BUT my hospital also went smoke free a few months ago, and honestly, my coworkers just find places to smoke. Give it a few weeks, and see what happens (although I do agree w PP about RAD and smoke).

It really sounds like your workplace is focusing on customer service at the cost of its coworkers. Maybe you guys need to bring a union in, or at the very least make your concerns known to management in a nice, respectful manner.

Good luck

Rnandsoccermom · Nov 1, 2006

In 21 years I've never worked anywhere that gave us a clothing allowance.

Most places allow covered drinks away from computers.

And in my area everyone has gone to designated smoking areas. Sorry.

nicolel1182 · Nov 1, 2006

I know it sucks, but yea they can do that, its all part of thinking of the whole, not the individual.

just try to hang in there

HARRN2b · Nov 1, 2006

I would not want a nurse taking care of me that had not had water of food for 12 hours, or even gone to the bathroom. If it is that bad, I would say bring on the unions.

KIAN · Nov 1, 2006

I have never worked at a place that provided uniforms unless it was for surgical or invasive procedures. I would come to work in my clothes and change into scrubs that they provided. Never took them home, they washed them.

Access to water would be an issue where you would have to demand and then take your breaks. Once again your bladder will pay the price.

Our institution has designated smoking areas but don't know how long that will last. I don't smoke.

You will find ways to make it work. You are a nurse and nurses are resourceful. Good luck.

Medic/Nurse, BSN, RN · Nov 1, 2006

I guess from a legal and ethical perspective that administration can "change" the rules that govern the workplace at will.

Is is good for morale? No. But my experience has been that morale is usually not high on the list of management concerns. Will it "cost" them nurses? I don't know. Maybe nurses are in high supply in your area.

As to the beverage restriction. Those usually lessen a bit with time. My solution is capped small bottles of water that fit in a small bag or jacket pocket. I will stay hydrated at work. Now you may not win your fight for the super size soda or venti Starbucks, but .... trying to go hours without water can be problematic. I had a nurse tell me that she actually was stricken with diverticulitis from low water intake during her nursing shifts. I think even administration could be convinced in the wisdom of allowing capped bottled water for employee consumption could be beneficial. But, then there are always some that will push the limits. Perhaps asking the administration for a written plan on how formal breaks (as required by law, in many cases) will be handled. He who creates the problems, owns the responsibility of a solution!

I will admit that the clothing requirements are a little rigid, but either you go along to get along or GET OUT. I don't get the immediate change now and then a change to the "whites" in just a couple of months, but ...

Could you just change to white now? I have every color of uniform known, been in over a dozen facilities and when I went to one that required "whites", I had to buy those! I will admit that the "white" requirement, although I groused about it at first, did have some advantages.

1. I thought it did look very professional.

2. Both the patients and myself could identify the NURSE very easily.

the downside,

My accountants eyes are gonna bug out when he sees my uniform expenditures for the year 2006! :) Oh, you can also deduct the expenses required for uniform care. I deduct $8 - 10/ week + for laundry (my hubby does not allow me to wash hospital garb in out household washer)

As to the smoking, I am a non-smoker. Never smoked. Not to start an all out war here, but I am against smoking on hospital campuses. Another poster detailed the RAD a patient suffered when a visitor who had smoke precipitants on their clothing arrived at their bedside - I imagine that smoking healthcare providers could carry the same risk to a patient. It is a well documented risk to some patients.

I think there are few things more inconsiderate than having the "flock" of nurses coming back from their "quick 2 minute ciggy break??" with that smell over their clothes/hair/breath. Imagine being a patient trapped in a bed with THAT nurse caring for you! So I support admin here. I used to avoid certain hospital entrances that had the "smokers" around them, I did not like to have that smell lingering on me. I though why take a bath, just to arrive at work smelling like you've been to a bar??? So... I guess this would be a good time to quit if you are motivated, many hospitals that restrict this will provide cessation classes, nicotine replacement. You could also check the areas health departments, many have classes and provide the gum/patch free of charge. Good Luck.

Well, you've got a choice. STAY or GO.

Uniforms, clearly not unethical or illegal.

Water/breaks - I think this can be overcome. Not providing breaks could be a violation of state employment laws.

Smoking Restriction- no unethical or illegal acts here. Could be a great time for health promotion!

Practice SAFE!

mtngrl, ASN, RN · Nov 1, 2006

As far as uniforms, I have never know anyplace to supply them or give a uniform allowance. But if you are used to that, I guess I'd be mad too.

The no snacks/drinks is totally stupid! That's usually the only food some nurses get! Do you really think they will enforce that? Shoot, at the hospital I used to work at, we'd have pizzas at the nurses station for all the nurses to share, everyone had a drink around too. I don't think we were supposed to have drinks by the computers but everyone did and no one ever said anything.

And for smoking, my past hospital was also smoke-free. I don't smoke myself, but I know that if you wanted to smoke you had to go smoke in your car. The parking lot was no smoking but if it's in your car then that was ok. Maybe that is what you will have to do. Hope you dont park miles away if thats the case!